Uninsured Americans often seek treatment in emergency rooms, such as this asthma sufferer at Coney Island Hospital in Brooklyn. While Congress has been expanding coverage for the very poor, students and lower-income workers are losing coverage. Today 45 million Americans lack health insurance. (Getty Images/Mario Tama)

Some 45 million Americans lacked health insurance in 2005 — a number that has been climbing for two decades. Every month, about 2 million Americans become uninsured, at least temporarily, as lower-paying service jobs with minimal benefits replace union-dominated manufacturing jobs with health benefits — undercutting the nation's employer-based coverage system. Health costs — rising faster than wages or inflation — also push employers to drop coverage. Past legislative proposals for universal coverage relied heavily on government management, drawing fatal opposition from physicians and insurance companies. But now consensus may be forming around proposals requiring most Americans to buy private insurance with public assistance. Republican governors in California and Massachusetts back such plans, as does former Sen. John Edwards, the first presidential hopeful to announce what's expected to be a slew of universal-coverage proposals in the coming 2008 election.